Bioactivity of Sodium Free Fluoride Containing Glasses and Glass-Ceramics

Marginal integrity of prototype bioactive glass-doped resin composites in class II cavities

OBJECTIVES

This in vitro study examined the marginal integrity of experimental composite materials doped with bioactive glass (BG).

MATERIALS AND METHODS

Class-II MOD cavities were prepared and restored with one of the following composite materials: a commercial composite material as a reference (Filtek Supreme XTE), an experimental composite doped with BG 45S5 (C-20), and an experimental composite doped with a fluoride-containing BG (F-20). Six experimental groups (n = 8) were used, as each of the three composites was applied with (+) or without (-) a universal adhesive (Adper Scotchbond Multipurpose). All specimens were subjected to thermocycling (10,000 x, 5-55 °C) and then additionally stored in artificial saliva for eight weeks. Scanning electron micrographs of the mesial and the distal box were taken at three time points (initial, after thermocycling, and after eight weeks of storage in artificial saliva). The margins were classified as "continuous" and "non-continuous" and the percentage of continuous margins (PCM) was statistically analyzed (α = 0.05).

RESULTS

In most experimental groups, thermocycling led to a significant decrease in PCM, while the additional 8-week aging had no significant effect. F-20 + performed significantly better (p = 0.005) after 8 weeks storage in artificial saliva than the reference material with adhesive, while no statistically significant differences were observed at the other two time points. C-20 + exhibited significantly better PCM than the reference material with adhesive after thermocycling (p = 0.026) and after 8 weeks (p = 0.003).

CONCLUSIONS

Overall, the experimental composites with BG showed at least as good marginal adaptation as the commercial reference, with an indication of possible re-sealing of marginal gaps.

CLINICAL RELEVANCE

Maintaining or improving the marginal integrity of composite restorations is important to prevent microleakage and its likely consequences such as pulp irritation and secondary caries.

Bioactive glass-ceramics containing fluorapatite, xonotlite, cuspidine and wollastonite form apatite faster than their corresponding glasses

Crystallisation of bioactive glasses has been claimed to negatively affect the ion release from bioactive glasses. Here, we compare ion release and mineralisation in Tris-HCl buffer solution for a series of glass-ceramics and their parent glasses in the system SiO2-CaO-P2O5-CaF2. Time-resolved X-ray diffraction analysis of glass-ceramic degradation, including quantification of crystal fractions by full pattern refinement, show that the glass-ceramics precipitated apatite faster than the corresponding glasses, in agreement with faster ion release from the glass-ceramics. Imaging by transmission electron microscopy and X-ray nano-computed tomography suggest that this accelerated degradation may be caused by the presence of nano-sized channels along the internal crystal/glassy matrix interfaces. In addition, the presence of crystalline fluorapatite in the glass-ceramics facilitated apatite nucleation and crystallisation during immersion. These results suggest that the popular view of bioactive glass crystallisation being a disadvantage for degradation, apatite formation and, subsequently, bioactivity may depend on the actual system study and, thus, has to be reconsidered.

Microcrystallization Effects in Borosilicate Bioactive Glasses: Controllable Release of Bioactive Elements and In Vitro Degradation Properties

Borosilicate bioactive glasses exhibit excellent bioactivity and degradation properties; however, they suffer from the rapid release of bioactive elements at the initial stage of their degradation. Excessive local concentrations (such as those of B) can affect cell proliferation. Moreover, the degradation and mineralization ability of these glasses deteriorate at the later stages. Aiming to balance the release of bioactive elements during the whole process, herein, a borosilicate bioactive glass 18SiO2-6Na2O-8K2O-8MgO-22CaO-2P2O5-36B2O3 (mol%) was prepared using the melting method. Further, the effects of microcrystallization on the release of bioactive elements and in vitro degradation were studied. Results show that after heat treatment at temperatures over 620 °C, multiple microcrystalline phases, including Ca2SiO4, CaB2O4, and CaMgB2O5, form in the glass. The glass samples heat-treated within the range of 620-640 °C undergo appropriate devitrification degrees, decelerating the rate of pH increase of the immersion solution during the initial stage in comparison to those treated at lower temperatures. This results in a more continuous release of all bioactive elements and allows better control of the overall degradation. Contrarily, the more extensive devitrification degrees of glass samples heat-treated at higher temperatures reverse the pH increase and degradation trends. Since bone marrow mesenchymal stem cells and mouse embryonic osteoblast cells are pH-sensitive, inducing a suitable degree of devitrification proved to favor cell viability and enhance the mineralization capacity. Thus, different microcrystallization degrees provide new approaches for controlling the degradation and release of bioactive elements, resulting in the simultaneous enhancement of biosafety and bioactivity.

Halide-containing bioactive glasses enhance osteogenesis in vitro and in vivo

The application of bone substitutes to reconstruct bone defects is a strategy for repairing alveolar bone loss caused by periodontal disease. Bioactive glasses (BGs) are attractive synthetic bone substitutes owing to their abilities to degrade, form bone-like mineral and stimulate bone regeneration. Our previous studies showed that the incorporation of fluoride into alkali-free bioactive silicate glass promoted osteogenesis to some extent in vitro, while the incorporation of chloride facilitated glass degradation and accelerated the formation of hydroxyapatite. However, whether there is a synergistic effect of incorporating fluoride and chloride on further enhancement of osteogenesis and angiogenesis in vitro and in vivo was not known. Therefore, we synthesized three halide-containing BGs with fluoride only, or chloride only, or mixed fluoride and chloride, investigated their physicochemical properties and osteogenic and angiogenic effects both in vitro and in vivo. The results showed that the addition of both fluoride and chloride in a bioactive silicate glass could combine the structural roles of both, leading to a faster apatite formation than the glass with the presence of fluoride only and a more stable fluorapatite formation than the glass with the presence of chloride only, which formed hydroxyapatite upon immersion. The studied BGs were cytocompatible, as suggested by the cytotoxicity evaluation of hPDLSCs cultivated in the extracted BGs-conditioned culture media. More importantly, these BGs stimulated osteogenic differentiation of hPDLSCs without adding growth factors as indicated by the fact that BGs-conditioned media up-regulated the expression of BMP-2, OPN and VEGF of hPDLSCs and promoted the formation of bone nodules and collagen in vitro. By comparison, the incorporation of fluoride facilitated the expression of osteogenic-related biomarkers and bone nodule formation preferentially, while the incorporation of chloride induced the expression of angiogenic-related biomarkers and collagen formation. The in vivo investigation results demonstrated that the developed halide-containing BGs accelerated the process of bone regeneration, while the glass with mixed fluoride and chloride showed the most significant promotion effect among the three BGs. Therefore, our findings revealed a synergistic effect of incorporating fluoride and chloride into a BG on osteogenesis and angiogenesis in vitro and in vivo and highlighted the potential of fluoride and chloride containing bioactive glasses being bone substitutes for clinical use.

Novel Fluoride- and Chloride-containing Bioactive Glasses for Use in Air Abrasion

OBJECTIVES

To investigate the degradation, fluorapatite formation, biological safety and cutting efficiency on dentine of the mixed fluoride- and chloride-containing bioactive glasses (BGs).

METHODS

Two series of mixed fluoride- and chloride-containing glasses (GPFCl and GPF2.3Cl series) were synthesized using a melt-quench method. Glass transition temperature (T_g) and the bioactivity in term of glass degradation and fluorapatite formation were evaluated in Tris buffer solution. The cutting efficiency of the powdered BGs (GPF2.3Cl series) on dentine via air abrasion was investigated using white light profilometry and scanning electron microscope. The cytotoxicity of GPF2.3Cl series on human periodontal ligament stem cells (hPLSCs) and oral fibroblasts (OFB) were examined by MTT.

RESULTS

These BGs are highly degradable and able to form fluorapatite within 3h of immersion. The formation of CaF₂ was also found in the high fluoride-containing BGs. The faster glass degradation was evidenced in the BGs with higher chloride. A significant reduction of T_g from 790°C to 463°C was seen with increasing in calcium halide content. Air abrasion on dentine using the low and intermediate chloride-containing glasses demonstrates clear depressions, while no depression was found using the high chloride-containing glass. Moreover, the studied BGs showed no cytotoxicity to hPLSCs and OFB.

CONCLUSIONS

The glasses with mixed fluoride and chloride integrate the benefits from the presence of both, showing rapid glass degradation, fast fluorapatite formation, excellent biocompatibility and controllable hardness to provide a selective cutting efficiency on dentine.

CLINICAL SIGNIFICANCE

The developed BGs air abrasive with tunable hardness by varying chloride content can selectively cut different dental tissues. In clinic, a relatively hard BG is of great interest for caries preparation, while a soft glass is attractive for tooth cleaning.

A study of bioactive glass-ceramic's mechanical properties, apatite formation, and medical applications

Apparently, bioactive glass-ceramics are made by doing a number of steps, such as creating a microstructure from dispersed crystals within the residual glass, which provides high bending strength, and apatite crystallizes on surfaces of glass-ceramics when calcium ions are present in the blood. Apatite crystals grow on the glass and ceramic surfaces due to the hydrated silica. These materials are biocompatible with living bone in a matter of weeks, don't weaken mechanically or histologically, and exhibit good osteointegration as well as mechanical properties that are therapeutically relevant, such as fracture toughness and flexural strength. As part of this study, we examined mechanical properties, process mechanisms involved in apatite formation, and potential applications for bioactive glass-ceramic in orthopedic surgery, including load-bearing devices.

Nano-imaging confirms improved apatite precipitation for high phosphate/silicate ratio bioactive glasses

Bioactive glasses convert to a biomimetic apatite when in contact with physiological solutions; however, the number and type of phases precipitating depends on glass composition and reactivity. This process is typically followed by X-ray diffraction and infrared spectroscopy. Here, we visualise surface mineralisation in a series of sodium-free bioactive glasses, using transmission electron microscopy (TEM) with energy-dispersive X-ray spectroscopy (EDXS) and X-ray nano-computed tomography (nano-CT). In the glasses, the phosphate content was increased while adding stoichiometric amounts of calcium to maintain phosphate in an orthophosphate environment in the glass. Calcium fluoride was added to keep the melting temperature low. TEM brought to light the presence of phosphate clustering and nearly crystalline calcium fluoride environments in the glasses. A combination of analytical methods, including solid-state NMR, shows how with increasing phosphate content in the glass, precipitation of calcium fluoride during immersion is superseded by fluorapatite precipitation. Nano-CT gives insight into bioactive glass particle morphology after immersion, while TEM illustrates how compositional changes in the glass affect microstructure at a sub-micron to nanometre-level.

The use of bioactive glass (BAG) in dental composites: A critical review

OBJECTIVE

In recent years, numerous studies have analyzed the role of bioactive glass (BAG) as remineralizing additives in dental restorative composites. This current review provides a critical analysis of the existing literature, particularly focusing on BAGs prepared via the melt-quench route that form an "apatite-like" phase when immersed in physiological-like solutions.

METHODS

Online databases (Science Direct, PubMed and Google Scholar) were used to collect data published from 1962 to 2020. The research papers were analyzed and the relevant papers were selected for this review. Sol-gel BAGs were not included in this review since it is not a cost-effective manufacturing technique that can be upscaled and is difficult to incorporate fluoride.

RESULTS

BAGs release Ca²⁺, PO₄^3- and F^- ions, raise the pH and form apatite. There are numerous published papers on the bioactivity of BAGs, but the different glass compositions, volume fractions, particle sizes, immersion media, time points, and the characterization techniques used, make comparison difficult. Several papers only use certain characterization techniques that do not provide a full picture of the behavior of the glass. It was noted that in most studies, mechanical properties were measured on dry samples, which does not replicate the conditions in the oral environment. Therefore, it is recommended that samples should be immersed for longer time periods in physiological solutions to mimic clinical environments.

SIGNIFICANCE

BAGs present major benefits in dentistry, especially their capacity to form apatite, which could potentially fill any marginal gaps produced due to polymerization shrinkage.

Phosphate/oxyfluorophosphate glass crystallization and its impact on dissolution and cytotoxicity

The role of fluorine in bioactive glasses is of interest due to the potential of precipitating fluorapatite, a phase with higher chemical resistance than the typical hydroxyapatite precipitated from oxide bioactive glasses. However, the introduction of fluorine in silicate bioactive glasses was found deleterious to the bioactivity of the glass. Here, phosphate glasses with the composition 75NaPO₃-(25-x) CaO-xCaF₂ (in mol%), with x = 0-20 and glass-ceramics were investigated to evaluate their potential as substitutes to the traditional silicate bioactive glass. An increase in CaF₂ substitution for CaO led to an increase in the glass solubility, due to an increase in highly soluble F(M)n species (where M is a cation) and to an increased polymerization of the phosphate network. Structural analysis reveals the formation of FP bonds, in addition to the F(M)n species, in the glass with the higher CaF₂ content. Furthermore, with heat treatment, CaF₂ crystals precipitate within the bulk in the newly developed glass, when x = 20. This bulk crystallization reduces the glass dissolution without compromising the precipitation of a reactive layer at the glass surface. Finally, in vitro cell tests were performed using MC3T3 pre-osteoblastic cells. While the substitution of CaF₂ for CaO led to an increased cytotoxicity, the controlled crystallization of the fluorine containing glasses decreased such cytotoxicity to similar values than traditional bioactive phosphate glass (x0). This study reports on new oxyfluorophosphate glass and glass-ceramics able, not only, to precipitate a Ca-P reactive layer but also to be processed into glass-ceramics with controlled crystal size, density and cellular activity. STATEMENT OF SIGNIFICANCE: Uncontrolled crystallization of bioactive glasses has negative effect on the materials' bioactivity. While in silicate glass the bioactivity is solely reduced, in phosphate glasses it is often completely suppressed. Furthermore, the need for fluorine containing bioactive glasses, not only for use in bone reconstruction but also in toothpaste as emerged. The addition of F in both silicate and phosphate has led to challenges due the lack of Si-F or P-F bonds, generally leading to a decrease in bioactivity. Here, we developed a bioactive invert phosphate glass where up to 20 mol% of CaO was replaced with CaF₂. In the new developed glasses, NMR demonstrated formation of P-F bonds. The content of fluorine was tailored to induce CaF₂ bulk crystallization. Overall an increase in F was associated with an increase network connectivity. In turns it led to an increased dissolution rate which was linked to a higher cytotoxicity. Upon (partial to full) surface crystallization of the F-free glass, the bioactivity (ability to form a reactive layer) was loss and the cytotoxicity again increased due to the rapid dissolution of one crystal phase and of the remaining amorphous phase. On another hand, the controlled bulk precipitation of CaF₂ crystals, in the F-containing glass, was associated with a reduced cytotoxicity. The new oxyfluorophosphate glass-ceramic developed is promising for application in the biomedical field.

Calcium carbonate: Adored and ignored in bioactivity assessment

The title of this article could sound a bit curious to some readers since a layer of apatite - and not calcium carbonate - is well-known to form on the surface of bioactive glasses upon immersion in simulated body fluids. However, calcium carbonate (commonly reported as calcite crystals) can form on the surface of bioactive glasses as well, instead of or in competition with hydroxyapatite, during in vitro tests. Major factors that govern calcium carbonate formation are a high concentration of Ca²⁺ ions in the testing solution - and, in this regard, glass composition/texture and type of medium play key roles - along with the volume of solution used during in vitro tests. To date, this phenomenon has received relatively little attention and is still partly unexplored. This article provides a critical overview of the available literature on this topic in order to stimulate constructive discussion among biomaterials scientists and further research for better understanding the mechanisms involved in glass bioactivity. STATEMENT OF SIGNIFICANCE: A literature search indicates that a layer of apatite - and not calcium carbonate - is well known to form on the surface of biomaterials during the bioactivity assessment. However, calcium carbonate can form on the surface as well, instead of or in competition with apatite. To date, this phenomenon has received relatively little attention and is still partly unexplored. This review provides a critical overview of the available literature on this topic in order to stimulate constructive discussions that can be further useful for clinical success.

High chloride content calcium silicate glasses

Chloride is known to volatilize from silicate glass melts and until now, only a limited number of studies on oxychloride silicate glasses have been reported. In this paper we have synthesized silicate glasses that retain large amounts of CaCl₂. The CaCl₂ has been added to the calcium metasilicate composition (CaO·SiO₂). Glasses were produced via a melt quench route and an average of 70% of the chloride was retained after melting. Up to 31.6 mol% CaCl₂ has been successfully incorporated into these silicate glasses without the occurrence of crystallization. ²⁹Si MAS-NMR spectra showed the silicon being present mainly as a Q² silicate species. This suggests that chloride formed Cl-Ca(n) species, rather than Si-Cl bonds. Upon increasing the CaCl₂ content, the T_g reduced markedly from 782 °C to 370 °C. Glass density and glass crystallization temperature decreased linearly with an increase in the CaCl₂ content. However, both linear regressions revealed a breakpoint at a CaCl₂ content just below 20 mol%. This might be attributed to a significant change in the structure and is also correlated with the nature of the crystallizing phases formed upon heat treatment. The glasses with less than 19.2 mol% CaCl₂ crystallized to wollastonite, whilst the compositions with CaCl₂ content equal to or greater than 19.2 mol% are thought to crystallize to CaCl₂. In practice, the crystallization of CaCl₂ could not occur until the crystallization temperature fell below the melting point of CaCl₂. The implications of the results along with the high chloride retention are discussed.

New Insight into Mixing Fluoride and Chloride in Bioactive Silicate Glasses

Adding fluoride into bioactive glasses leads to fluorapatite formation and a decrease in glass transition temperature. Recently, chloride has been introduced into glasses as an alternative to fluoride. The presence of the large chloride ion lowers glass crystallisation tendency and increases glass molar volume, which effectively facilitates glass degradation and bone-bonding apatite-like layer formation. However, there is no information regarding the effect of mixing fluoride and chloride on the glass structure and properties. This study aims to synthesize mixed fluoride and chloride containing bioactive glasses; investigate the structural role of fluoride and chloride and their effects on glass properties. The chloride content measurements reveal that 77–90% of chloride was retained in these Q² type glasses. Glass transition temperature reduced markedly with an increase in CaX₂ (X = F + Cl) content, while the glass molar volume increased. ²⁹Si MAS-NMR results show that the incorporation of mixed fluoride and chloride did not cause significant change in the polymerization of the silicate network and no detectable concentration of Si-F/Cl bands were present. This agrees with ¹⁹F NMR spectra showing that F existed as F-Ca(n) species.

Sodium Is Not Essential for High Bioactivity of Glasses

This study aims to demonstrate that excellent bioactivity of glass can be achieved without the presence of an alkali metal component in glass composition. In vitro bioactivity of two sodium-free glasses based on the quaternary system SiO₂-P₂O₅-CaO-CaF₂ with 0 and 4.5 mol% CaF₂ content was investigated and compared with the sodium containing glasses with equivalent amount of CaF₂. The formation of apatite after immersion in Tris buffer was followed by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), ³¹P and ¹⁹F solid state MAS-NMR. The dissolution study was completed by ion release measurements in Tris buffer. The results show that sodium free bioactive glasses formed apatite at 3 hours of immersion in Tris buffer, which is as fast as the corresponding sodium containing composition. This signifies that sodium is not an essential component in bioactive glasses and it is possible to make equally degradable bioactive glasses with or without sodium. The results presented here also emphasize the central role of the glass compositions design which is based on understanding of structural role of components and/or predicting the network connectivity of glasses.

Sodium-free mixed alkali bioactive glasses

Two sodium-free mixed alkali series of bioactive glasses based on compositions Bioglass 45S5 and ICIE1, containing lithium and/or potassium as alkali ions, were prepared by a melt-quench route. Thermal properties showed the well-known mixed alkali effect, with glass transition and crystallisation temperatures and the coefficient of thermal expansion going either through a minimum or a maximum for the mixed alkali composition, resulting in a wider processing window. Ion release, by contrast, was controlled by the modifier ionic radius, with ion release rates in dynamic and static dissolution studies increasing for potassium-substituted glasses compared to the composition containing lithium as the only alkali ion. This was caused by pronounced changes in oxygen packing density and molar volume of the glasses owing to the differences in ionic radii (76 pm for Li+ and 138 pm for K+). Partially substituting one alkali for another therefore helps to improve high temperature processing of bioactive glasses and can also be used to control or tailor ion release.

Comparing the Air Abrasion Cutting Efficacy of Dentine Using a Fluoride-Containing Bioactive Glass versus an Alumina Abrasive: An In Vitro Study

Air abrasion as a caries removal technique is less aggressive than conventional techniques and is compatible for use with adhesive restorative materials. Alumina, while being currently the most common abrasive used for cutting, has controversial health and safety issues and no remineralisation properties. The alternative, a bioactive glass, 45S5, has the advantage of promoting hard tissue remineralisation. However, 45S5 is slow as a cutting abrasive and lacks fluoride in its formulation. The aim of this study was to compare the cutting efficacy of dentine using a customised fluoride-containing bioactive glass Na0SR (38-80 μm) versus the conventional alumina abrasive (29 μm) in an air abrasion set-up. Fluoride was incorporated into Na0SR to enhance its remineralisation properties while strontium was included to increase its radiopacity. Powder outflow rate was recorded prior to the cutting tests. Principal air abrasion cutting tests were carried out on pristine ivory dentine. The abrasion depths were quantified and compared using X-ray microtomography. Na0SR was found to create deeper cavities than alumina (p < 0.05) despite its lower powder outflow rate and predictably reduced hardness. The sharper edges of the Na0SR glass particles might improve the cutting efficiency. In conclusion, Na0SR was more efficacious than alumina for air abrasion cutting of dentine.

Bioactive glasses—structure and properties

Bioactive glasses were the first synthetic materials to show bonding to bone, and they are successfully used for bone regeneration. They can degrade in the body at a rate matching that of bone formation, and through a combination of apatite crystallization on their surface and ion release they stimulate bone cell proliferation, which results in the formation of new bone. Despite their excellent properties and although they have been in clinical use for nearly thirty years, their current range of clinical applications is still small. Latest research focuses on developing new compositions to address clinical needs, including glasses for treating osteoporosis, with antibacterial properties, or for the sintering of scaffolds with improved mechanical stability. This Review discusses how the glass structure controls the properties, and shows how a structure-based design may pave the way towards new bioactive glass implants for bone regeneration.

Novel Highly Degradable Chloride Containing Bioactive Glasses

Addition of CaF2 to a silicate bioactive glass favours formation of fluorapatite, which is less soluble in acidic environment than hydroxyapatite. However, excess CaF2 in the glass is problematic, owing to the formation of crystalline calcium fluoride rather than fluorapatite on immersion. In this paper we investigate chloride as an alternative to fluoride in bioactive silicate glasses and in particular their bioactivity for the first time. Meltderived bioactive glasses based on SiO2-P2O5-CaO-CaCl2 with varying CaCl2 contents were synthesised and characterised by DSC. Chemical analysis of the chloride content was performed by using an ion selective electrode. Glass density was determined using Helium Pycnometry. The glass bioactivity was investigated in Tris buffer. Ion release measurements were carried out by using ICP-OES. The chemical analysis results indicated that the majority of the chloride is retained in the Q2 type silicate glasses during synthesis. Tg and glass density reduced with increasing CaCl2 content. Apatite-like phase formation was confirmed by FITR, XRD and 31P MAS-NMR. The results of the in vitro studies demonstrated that the chloride containing bioactive glasses are highly degradable and form apatite-like phase within three hours in Tris buffer and, therefore, are certainly suitable for use in remineralising toothpastes. The dissolution rate of the glass was found to increase with CaCl2 content. Faster dissolving bioactive glasses may be attractive for more resorbable bone grafts and scaffolds.